Endotoxic shock. Part I: A review of causes.

Endotoxic shock is a complex phenomenon resulting from systemic release of inflammatory mediators. Endotoxin interacts with inflammatory cells, platelets, and vascular endothelium. Cytokines, such as tumor necrosis factor and interleukins, and lipid mediators (platelet activating factor, thromboxane, prostacyclin, leukotrienes) are released. These primary mediators act synergistically to cause many of the harmful effects associated with endotoxemia. Multiple secondary mediators are released in response to the primary mediators, compounding the damage. The end result is the species-specific clinical syndrome recognized as endotoxemia.